To move the following Clause—
“Sale of vaping products and nicotine products
(1) The Secretary of State may by regulations prevent the sale of to anyone born
after 1 January 2015—(a) vaping products; or
(b) nicotine products.(2) Regulations made under subsection (1) must specify an exemption for products prescribed by a clinician
(3) Regulations under this section:
(a) shall be made by statutory instrument; and
(b) may not be made unless a draft has been laid and approved by resolution of both Houses of Parliament.(4) Prior to making any regulations under subsection (1), and within 12 months of this Act coming into force, the Secretary of State must commission an independent evaluation of the health impacts of the matters under subsection (1) and must lay the report of the evaluation before Parliament.”Member's explanatory statement:
This new clause would allow the Secretary of State, by regulations, to prevent the sale of vaping and nicotine products to anyone born after 1 January 2015 after having laid before Parliament an independent evaluation report on the health impact of doing so.
Tuesday 14 May 2024
Could the Tobacco and Vapes Bill be any worse? MPs hope so.
Monday 13 May 2024
Obesity and worklessness
There has certainly been a rise in worklessness since the pandemic. The number of people of working age who are economically inactive has risen from 8.5 million to 9.4 million. This includes 2.8 million people who say they are too sick to work. Almost all of the increase in economic inactivity is explained by this rise in long-term sickness.
Is obesity the ‘root cause’ of the problem? It seems unlikely. Despite obesity rates rising for several decades, there had been no increase in the number of people off work with long-term illness since the 1990s. Between 2000 and 2019, the number actually fell – from 2.3 million to 2 million, but since 2020 another 800,000 people have suddenly joined their ranks.
Friday 10 May 2024
Rampant misinformation at the Tobacco and Vapes Bill committee
The UK Vaping Industry Association has written to MPs to raise concerns about the ‘misleading, incomplete, unsubstantiated, or incorrect’ information presented to the Tobacco and Vapes Bill Committee last week. The UKVIA should have been invited to give evidence to the committee (it has no links to the tobacco industry and therefore could not be disqualified on the usual McCarthyite grounds) but it wasn't. Instead, the floor was given to rabid anti-vapers, mendacious fanatics and hopeless ignoramuses.
Sheila Duffy, Chief Executive of Action on Smoking and Health (ASH): “There is a link between regular vaping and moving onto smoking..."
Laura Young, PhD Researcher from the Centre for Water Law, Policy and Science at the University of Dundee: “The first thing to remember is that vaping is not good for you. It is slightly better than smoking...”
“Because the evidence was mainly given by those who have spoken out against vaping in the past, it presented a very skewed message which often conflated the legal compliant vape industry with the black market and frequently made no distinction between the tobacco and vaping industries.
“We recognise there are illegal traders in our industry who will sell to children, and criminal gangs who import black market devices, which can contain illegal and dangerous substances. The legitimate and majority side of the sector want to rid the country of this scourge on society and see them prosecuted, punished and driven out of business. To equate the illegal and legal vaping sectors is as unfair as saying that illegal immigrant smugglers and the Dover to Calais ferry do the same thing. One is illegal and needs to be stopped, the other performs a helpful and beneficial service.
“We are also not trying to water down, delay or circumvent the legislation but we do want to ensure that when MPs scrutinise this Bill they are doing so from an informed perspective which comes from fact not fiction. In scrutinising this Bill, MPs must balance the rights and needs of adult smokers to have access to the very best products to help them quit, with those of young people to be protected from age-restricted products, including vaping.
“This by no means is an easy path to navigate and it will be made even more treacherous whenever evidence presented to the Committee is so misleading that it does more harm than good. Not only does the underhand management of the Bill Committee’s oral evidence session risk the Bill not facing proper scrutiny prior to its third reading, but the selection process across the board was fundamentally undemocratic, with the people this Bill will impact the most not being able to provide evidence on how it can be improved.
“It is another example of the growing list of decisions by the Department of Health and Social Care to exclude the UKVIA and wider industry from any meaningful collaboration with the Department."
Thursday 9 May 2024
Everything is displacement
In 2018, Dr Lisa Cameron, an MP from the Scottish National Party, called for the consumption of dog meat to be banned in the United Kingdom. There was no evidence that anyone in Britain was eating dogs and she was surely correct when she said that “I do not believe the general public would approve of the practice at all”. The sale of dog meat has been banned for many years, but Dr Cameron was concerned about a loophole that allows people to eat their own dog if the animal has been humanely killed. Appalled at the prospect of this hypothetical problem, she urged the government to “take action to nip it in the bud”. The Conservative minister Sir Alan Duncan immediately rallied to the cause, saying: “There is no need in the modern world for this disgusting habit.” Like Dr Cameron, he said the government “should nip it in the bud”.
Somewhat surprisingly, the campaign gathered steam. Jim Shannon MP said that “it is obscene, gross and immoral that someone could, technically speaking, cook a dog and eat it”. Following such newspaper headlines as “Horror of DOG EATING in the UK – Theresa May urged to act” (Daily Express), questions were asked in both Houses of Parliament and the House of Commons library prepared a 13 page briefing on the issue in advance of an hour long debate in the House of Commons. The debate was triggered by a Ten-minute Rule Bill from the Conservative MP Bill Wiggin who admitted that “there is no evidence that dogs are eaten in the UK” but that Britain should be “setting an example to the world”. By the summer of 2019, Michael Gove had reportedly drafted legislation to make the possession of dog meat a criminal offence. Alas, the clampdown on theoretical dog-eating fizzled out when civil servants decided that a ban would be “culturally insensitive”.
In its small way, this episode sums up the last 14 years of government. The sheer inanity of it, the entanglement in trivia, the virtue signalling, the use of legislation to “send a message”, the inevitable involvement of Michael Gove and the whole thing falling apart for fear of seeming racist. It is a canned version of the whole era. Unserious politicians in serious times will do anything to avoid grasping the nettle. Everything is displacement.
Tuesday 7 May 2024
Ultra-processed food - my comments to the House of Lords
The House of Lords Food, Diet and Obesity Committee started its pointless proceedings in February and is still slogging on. It has managed to avoid asking anybody who is sceptical of the ultra-processed food panic from appearing (last week it heard from three 'ambassadors' from the Food Foundation and three 'ambassadors' from Jamie Oliver's BiteBack front group). The committee did, however, ask for written submissions so this is what I sent them back in February after Dimbleby, Spector and Coco Pops guy kicked things off....
I was concerned to see that six out of the seven people who appeared at your first three oral evidence sessions were activists and/or authors who subscribe to a particular view of the food system and favour heavy regulation. Whilst I am sure you plan to invite some mainstream scientists, economists and consumers to future sessions, I felt it might be of use to respond to some of the questions in your call for written evidence below.
The definition of a) ultra-processed food (UPF) and b) foods high in fat, sugar and salt (HFSS) and their usefulness as terminologies for describing and assessing such products.
The official HFSS definition, which campaigners use as the implicit definition of ‘junk food’, creates many absurdities, partly because the limits laid out in the Nutrient Profiling Model (NPM) are so low. HFSS food includes raisins, sultanas, most tinned fruit, most yoghurts, two-thirds of morning goods, nearly all cheese, cream crackers, tomato soup, hummus, ham, pesto, cereal bars, olive bread and salami. Whether these foods are ‘high’ in fat, sugar and/or salt is a matter of opinion, but few people would view all of them as ‘junk food’ and want to ban them from being advertised. It is doubtful whether the general public considers even very high sugar foods like jam or very high fat foods like butter to be ‘junk food’.
Campaigners such as Jamie Oliver have exploited the confusion about what ‘junk food’ is (it has no scientific definition and is legally meaningless) to push for legislation against the much broader category of HFSS food. Having capitulated to these campaigners in 2020, the government has tacitly acknowledged that it bought a pig in a poke by exempting a number of HFSS foods from its list of ‘less healthy’ food in the Health and Care Act (2022). There is no scientific justification for exempting these foods - the NPM has the virtue of at least being consistent - but they are so far removed from the popular idea of junk food that the government would look ridiculous if it included them.
‘Ultra-processed food’ is an even broader category which demonises the vast majority of food that isn’t eaten raw or prepared by hand in a domestic kitchen. As a phrase, it was never uttered in the House of Lords until 2020 but there has been a flurry of mentions and several specific debates in the chamber since Chris van Tulleken published his book Ultra-Processed People in April 2023. Van Tulleken is responsible for introducing many people to the concept of UPFs. He makes many claims in his book and in his media appearances that are at best contentious and at worst demonstrably false. For example, based on a misreading of an academic study, he falsely claims in Ultra-Processed People that Chilean miners burn the same number of calories as sedentary office workers and that exercise therefore does not help people lose weight. He has falsely claimed on Twitter/X that the very idea that exercise assists weight loss was invented by the Coca-Cola company.
‘the association between UPF consumption and the risk of multimorbidity would disappear if the data were adjusted not only for the consumption of sugary or artificially sweetened beverages, but also for foods of animal origin at the same time. Indeed, in our opinion, the article underlines the absolute need to return to the evaluation of foods on the basis of their nutritional role (including their nutrient composition, quantities consumed, metabolic effects, etc.) and not on the basis of their degree of processing.’
One peculiarity about the UPF system is that some of the few ingredients that are not portrayed as inherently dangerous are fat, sugar and salt. So long as they are used to make cakes, biscuits, etc. in a domestic kitchen, they are de facto healthy. It is the industrial processing, not the nutrients, that somehow creates the risk. This not only turns the scientific consensus of recent decades on its head but is palpable nonsense and it is a sign of how quickly the West is retreating from Enlightenment values that anyone is taking it seriously.
Growing fanaticism from certain policy entrepreneurs would lead us to portray a large number of food products as inherently dangerous and urge us to abstain from them all. This is not only unscientific but useless in terms of practical public policy because people are never going to abstain from eating chocolate and bacon let alone sliced bread.
The cost and availability of a) UPF and b) HFSS foods and their impact on health outcomes.
Processed/HFSS/UPF food is typically more expensive than what the government defines as healthy food (fruit, vegetables, starchy carbohydrates, white meat, etc.). Campaigners often claim the opposite by comparing food prices using the cost-per-calorie method. This turns the virtue of being low in calories into a vice since the cost-per-calorie naturally rises as the number of calories in the product declines. A better method is to measure the cost per meal or the cost per kilogram. Under these measures, the cost of healthy eating is relatively low and is far lower than the cost of eating takeaways and fast food (Snowdon 2017).
The impact on heath of HFSS and UPF has been partially addressed in the previous answer, but it is worth mentioning the study by Kevin Hall et al. (2019) which will doubtless be cited a lot in the written and oral evidence to your inquiry. By the low standards of nutritional science, this was a well conducted randomised controlled trial. It found that the people who ate the UPF diets consumed significantly more calories than those on the non-UPF diet and that the former gained weight while the later lost weight. Unfortunately, due to cost pressures, the researchers were not able to offer UPF and non-UPF versions of the same meal. Instead, the UPF group was given a diet that differed more fundamentally than in the way it was processed. For example, one lunch consisted of burger and fries for the UPF group while the non-UPF group got salmon and green beans. The non-UPF food was not merely non-UPF, but was minimally processed which perhaps explains why those who ate it lost weight. As a control group, it would have been more useful (and more realistic) to give them processed (but not ultra-processed) food. The hypothesis that ultra-processing causes over-eating/obesity can only really be tested by giving people processed and ultra-processed versions of the same meal, but no RCT has yet done this to my knowledge.
Lessons learned from international policy and practice, and from the devolved administrations, on diet-related obesity prevention.
I am aware of no country that has reduced obesity rates through deliberate government action (although a few socialist countries have done so as an unintended consequence of its economic policies, e.g. Venezuela). An obvious approach would be to look at comparable countries that have significantly lower rates of obesity than the UK and emulate their policies. This is rarely suggested by ‘public health’ campaigners, presumably because countries with lower obesity rates do not have the kind of taxes and bans they support.
The impact of recent policy tools and legislative measures intended to prevent obesity.
The most significant measure in recent years has been the sugar tax which plainly had no impact on childhood obesity (rates of which rose for three successive years after it was introduced). The ban on HFSS food advertising on television during children’s programmes also failed to have any impact on rates of obesity. Food reformulation didn’t work because consumers couldn’t be forced to eat the reformulated products. It is highly doubtful that forthcoming bans on advertising and promotion will lead to a decline in obesity. Even the government’s own Impact Assessment, based on a starry-eyed interpretation of weak and biased research, only predicts a trivial effect on calorie consumption.
The persistent failure of anti-obesity policies to reduce obesity never leads to any apologies or resignations from the activists and academics who campaign for them. Rather than repealing unsuccessful policies, governments tend to double down with further restrictions, thereby creating a runaway train of regressive, anti-competitive policies that logically leads to some form of prohibition (as we are now seeing with tobacco). Policy entrepreneurs who seek to regulate the food supply are in the privileged position of never having to show that their policies work. This sets them apart from doctors and nurses who cannot, in the modern era, get away with conducting unnecessary and harmful operations or prescribing useless drugs.
No one expects a single policy to reduce obesity rates to zero, but it should not be too much to ask for them to reduce them by a little bit, even if only a fraction of one per cent. This, however, has so far been beyond the purported experts of Britain’s lavishly funded ‘public health’ institutions. To disguise their failings, they have invented something called the ‘whole systems approach’ to obesity which amounts to throwing as many untested and unproven policies at the problem as possible, regardless of cost and unintended consequences, in the hope that one or more of them might work. When each of them predictably fails to move the dial, they mutter something about there being ‘no silver bullet’ and move on to the next idea. This, I submit, is neither a wise nor evidence-based approach to policy-making.
Saturday 4 May 2024
A swift half with Erik Matson
A new episode of The Swift Half dropped this week. I spoke to Erik Matson, an American academic who is an expert on Adam Smith and David Hume, to discuss the lessons of those great thinkers in relation to the new paternalism (i.e. nudge theory). You can read his IEA book New Paternalism Meets Older Wisdom for free.
Friday 3 May 2024
Tobacco and Vapes Bill committee: day two
Chris Whitty (chief medical officer for England): "I think I speak on behalf of all the chief medical officers when I say we enormously welcome the Bill, which I think the overwhelming majority of doctors, nurses and other healthcare workers fully support. It is an extraordinarily important public health measure."
Francis Atherton (chief medical officer for Wales): "To echo what Sir Chris has said, it is rare to achieve such a high degree of consensus across the medical community as there is around this Bill."
Gregor Ian Smith (chief medical officer for Scotland): "I would reiterate every word that Sir Frank has just said. The consensus across the medical profession, as far as I can see, is absolute."
Michael McBride (chief medical officer in Northern Ireland): "I would echo all that has been said. To add to Sir Gregor’s point about the weight of professional opinion, in Northern Ireland we also have the weight of a huge majority of the public. They are hugely supportive of the smoke-free generation and of measures on displays, point of sale and flavours of vapes."
Stephen Powis (national medical director of NHS England): "Seventy-eight years ago, Parliament passed the National Health Service Act 1946, which led to the formation of the NHS on 5 July 1948. In my view, the legislation that you are considering here today is one of the most important—possibly the most important—pieces of legislation since the passage of that Act."
Kate Brintworth (chief midwifery officer for NHS England): "... all the chief nursing and midwifery officers across the four countries are united in support of the Bill, as our medical colleagues are, because we see the damage wrought across families and generations. We are 100% behind it."
Kamila Hawthorne (a GP in south Wales): "I see a smoke-free generation as the logical next step, and I really think we have to take it."
Steve Turner (president of the College of Paediatrics and Child Health): "...we believe this Bill is splendid. We would be happy for the version that we have seen to be approved unamended."
Sanjay Agrawal (Royal College of Physicians): "The RCP supports the Bill. It is really well balanced. As a clinician in the medical profession, I, along with the RCP, which represents at least 30 different medical specialties, support the Bill. We know it will prevent ill health for future generations and reduce poverty and disparity."
Tim Mitchell (president of the Royal College of Surgeons): "We as a college fully support the Bill and, as my colleague said, we very much hope that it will pass through smoothly and get on to the statute book."
Mark Rowland (chief executive of the Mental Health Foundation): "... this Government should be applauded for introducing this progressive, bold and far-sighted piece of legislation."
Dr Laura Squire (Medicines and Healthcare products Regulatory Agency): "... anything that introduces more controls over consumer vapes has to be a good thing."
Ann McNeill (King’s College London): "I welcome the Bill... It is really important, moving forward, that the Bill is in the context of a comprehensive tobacco control strategy".
Robert West (Diet Sage communist): "...there is widespread support for what some in years gone past might have seen as quite a draconian Bill that phases out smoking. That is testimony to how far we have come with the policies we have adopted, with credit to successive Governments".
Only David Lawson (director of Inter Scientific Ltd.) came out of it with any credit. Although he did not oppose the generational ban, he did point out that the problems the committee had with vaping could be dealt with by enforcing the many laws that already exist. Naturally, he was the only witness to get the 'who funds you?' treatment.
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